Evaluation of a trough-only extrapolated area under the curve vancomycin dosing method on clinical outcomes
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RESEARCH ARTICLE
Evaluation of a trough‑only extrapolated area under the curve vancomycin dosing method on clinical outcomes Jacob Lines1,2 · Jessica Burchette3 · Susan M. Kullab4 · Paul Lewis1 Received: 10 March 2020 / Accepted: 17 September 2020 © Springer Nature Switzerland AG 2020
Abstract Background Vancomycin dosing strategies targeting trough concentrations of 15–20 mg/L are no longer supported due to lack of efficacy evidence and increased risk of nephrotoxicity. Area-under-the-curve (AUC24) nomograms have demonstrated adequate attainment of AUC24 goals ≥ 400 mg h/L with more conservative troughs (10–15 mg/L). Objective The purpose of this study is to clinically validate a vancomycin AUC24 dosing nomogram compared to conventional dosing methods with regards to therapeutic failure and rates of acute kidney injury. Setting This study was conducted at a tertiary, community, teaching hospital in the United States. Method This retrospective, cohort study compared the rates of therapeutic failures between AUC24-extrapolated dosing and conventional dosing methods. Main outcome measure Primary outcome was treatment failure, defined as all-cause mortality within 30 days, persistent positive methicillin-resistant Staphylococcus aureus blood culture, or clinical failure. Rates of acute kidney injury in non-dialysis patients was a secondary endpoint. Results There were 96 participants in the extrapolated-AUC24 cohort and 60 participants in the conventional cohort. Baseline characteristics were similar between cohorts. Failure rates were 11.5% (11/96) in the extrapolated-AUC24 group compared to 18.3% (11/60) in the conventional group (p = 0.245). Reasons for failure were 6 deaths and 5 clinical failures in the extrapolated-AUC24 cohort and 10 deaths and 1 clinical failure in the conventional group. Acute kidney injury rates were 2.7% (2/73) and 16.4% (9/55) in the extrapolated-AUC24 and conventional cohorts, respectively (p = 0.009). Conclusion Extrapolated-AUC24 dosing was associated with less nephrotoxicity without an increase in treatment failures for bloodstream infections compared to conventional dosing. Further investigation is warranted to determine the relationship between extrapolated-AUC24 dosing and clinical failures. Keywords Area under the curve · Bacteremia · Infectious disease · Methicillin-resistant · Staphylococcus aureus · Vancomycin
Impacts on practice Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11096-020-01157-3) contains supplementary material, which is available to authorized users. * Paul Lewis [email protected] 1
Department of Pharmacy, Johnson City Medical Center, 400 North State of Franklin Road, Johnson City, TN, USA
2
East Tennessee State University Physicians Infectious Diseases Clinic, Johnson City, TN, USA
3
Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
4
Department of Infectious, Inflammatory and Immunologic Diseases, East Tennessee
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